Sleep and Breathing

, Volume 17, Issue 1, pp 259–266 | Cite as

Validation of ApneaLink Ox™ for the diagnosis of obstructive sleep apnea

  • Carlos Alberto Nigro
  • Eduardo Dibur
  • Silvana Malnis
  • Sofia Grandval
  • Facundo Nogueira
Original Article



The aim of the study was to validate the automatic and manual analysis of ApneaLink Ox™ (ALOX) in patients with suspected obstructive sleep apnea (OSA).


All patients with suspected OSA had a polysomnography (PSG) and an ALOX performed in the sleep laboratory. For automatic analysis, hypopnea was defined as a decrease in airflow ≥30 % of baseline for at least 10 s plus oxygen desaturation ≥3 or 4 %. While for the manual analysis, hypopnoea was considered when a reduction of airflow ≥30 % of ≥10 s plus oxygen desaturation ≥3 % or increase in cardiac rate ≥5 beats/min were identified or, when only a reduction of airflow ≥50 % was observed. OSA was defined as a respiratory disturbance index (RDI) ≥5. The apnea/hypopnea automatic index (AHI3-a, AHI4-a) and manual index were estimated. Receiver operating characteristics (ROC) analysis and the agreement between ALOX and PSG were performed.


Fifty-five patients were included (38 men; mean age, 48.2; median, RDI 15.1; median BMI, 30 Kg/m2). The automatic analysis of ALOX under-estimated the RDI from PSG, mainly for the criterion of oxygen desaturation ≥4 % (AHI3-a–RDI, −3.6 ± 10.1; AHI4-a–RDI, −6.5 ± 10.9, p < 0.05). The autoscoring from ALOX device showed a better performance when it was set up to identify hypopneas with an oxygen desaturation criterion of ≥3 % than when it was configured with an oxygen desaturation criterion of ≥4 % (area under the receiver operator curves, 0.87 vs. 0.84). Also, the manual analysis was found to be better than the autoscoring set up with an oxygen desaturation of ≥3 % (0.923 vs. 0.87). The manual analysis showed a good interobserver agreement for the classification of patients with or without OSA (k = 0.81).


The AHI obtained automatically from the ApneaLink Ox™ using oxygen desaturation ≥3 % as a criterion of hypopnea had a good performance to diagnose OSA. The manual scoring from ApneaLink Ox™ was better than the automatic scoring to discriminate patients with OSA.


Portable sleep monitoring Obstructive sleep apnea Sleep apnea syndromes Diagnosis 



The authors wish to thank Ms. Jaquelina Mastantuono for revising the English text.

Disclosure of financial support


Disclosure of any conflicts of interest

Carlos A. Nigro received two ApneaLink Ox devices by the company AirLiquide Argentina to perform this study.


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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Carlos Alberto Nigro
    • 1
    • 3
  • Eduardo Dibur
    • 1
    • 4
  • Silvana Malnis
    • 1
    • 4
  • Sofia Grandval
    • 2
    • 5
  • Facundo Nogueira
    • 2
    • 5
  1. 1.Sleep Laboratory, Pneumonology UnitHospital AlemánBuenos AiresArgentina
  2. 2.Instituto Argentino de Investigación NeurológicaBuenos AiresArgentina
  3. 3.Buenos AiresArgentina
  4. 4.Buenos AiresArgentina
  5. 5.Buenos AiresArgentina

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